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Metabolic heterogeneity on baseline 18FDG-PET/CT scan is a predictor of outcome in primary mediastinal B-cell lymphoma

Metabolic heterogeneity on baseline 18FDG-PET/CT scan is a predictor of outcome in primary mediastinal B-cell lymphoma
Metabolic heterogeneity on baseline 18FDG-PET/CT scan is a predictor of outcome in primary mediastinal B-cell lymphoma

An important unmet need in the management of primary mediastinal B-cell lymphoma (PMBCL) is to identify the patients for whom first-line therapy will fail to intervene before the lymphoma becomes refractory. High heterogeneity of intratumoral 18F-fluorodeoxyglucose (18FDG) uptake distribution on positron emission tomography/computed tomography (PET/ CT) scans has been suggested as a possible marker of chemoresistance in solid tumors. In the present study, we investigated the prognostic value of metabolic heterogeneity (MH) in 103 patients with PMBCL prospectively enrolled in the International Extranodal Lymphoma Study Group (IELSG) 26 study, aimed at clarifying the role of PET in this lymphoma subtype. MH was estimated using the area under curve of cumulative standardized uptake value-volume histogram (AUC-CSH) method. Progression-free survival at 5 years was 94% vs 73% in low- and high-MH groups, respectively (P 5 .0001). In a Cox model of progression-free survival including dichotomized MH, metabolic tumor volume, total lesion glycolysis (TLG), international prognostic index, and tumor bulk (mediastinal mass > 10 cm), as well as age as a continuous variable, only TLG (P < .001) and MH (P < .001) retained statistical significance. Using these 2 features to construct a simple prognostic model resulted in early and accurate (positive predictive value, 89%; negative predictive value, ‡90%) identification of patients at high risk for progression at a point that would allow the use of risk-adapted treatments. This may provide an important opportunity for the design of future trials aimed at helping the minority of patients who harbor chemorefractory PMBCL.

0006-4971
179-186
Ceriani, Luca
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Milan, Lisa
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Martelli, Maurizio
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Ferreri, Andrés J.M.
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Cascione, Luciano
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Zinzani, Pier Luigi
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Di Rocco, Alice
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Conconi, Annarita
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Stathis, Anastasios
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Cavalli, Franco
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Bellei, Monica
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Cozens, Kelly
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Porro, Elena
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Giovanella, Luca
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Johnson, Peter W.
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Zucca, Emanuele
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Ceriani, Luca
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Milan, Lisa
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Martelli, Maurizio
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Ferreri, Andrés J.M.
ce2b2989-3888-49b5-a623-5094175db3d7
Cascione, Luciano
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Zinzani, Pier Luigi
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Di Rocco, Alice
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Conconi, Annarita
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Stathis, Anastasios
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Cavalli, Franco
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Bellei, Monica
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Cozens, Kelly
ad334c90-643c-4e72-a957-7d3d15a938ce
Porro, Elena
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Giovanella, Luca
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Johnson, Peter W.
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Zucca, Emanuele
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Ceriani, Luca, Milan, Lisa, Martelli, Maurizio, Ferreri, Andrés J.M., Cascione, Luciano, Zinzani, Pier Luigi, Di Rocco, Alice, Conconi, Annarita, Stathis, Anastasios, Cavalli, Franco, Bellei, Monica, Cozens, Kelly, Porro, Elena, Giovanella, Luca, Johnson, Peter W. and Zucca, Emanuele (2018) Metabolic heterogeneity on baseline 18FDG-PET/CT scan is a predictor of outcome in primary mediastinal B-cell lymphoma. Blood, 132 (2), 179-186. (doi:10.1182/blood-2018-01-826958).

Record type: Article

Abstract

An important unmet need in the management of primary mediastinal B-cell lymphoma (PMBCL) is to identify the patients for whom first-line therapy will fail to intervene before the lymphoma becomes refractory. High heterogeneity of intratumoral 18F-fluorodeoxyglucose (18FDG) uptake distribution on positron emission tomography/computed tomography (PET/ CT) scans has been suggested as a possible marker of chemoresistance in solid tumors. In the present study, we investigated the prognostic value of metabolic heterogeneity (MH) in 103 patients with PMBCL prospectively enrolled in the International Extranodal Lymphoma Study Group (IELSG) 26 study, aimed at clarifying the role of PET in this lymphoma subtype. MH was estimated using the area under curve of cumulative standardized uptake value-volume histogram (AUC-CSH) method. Progression-free survival at 5 years was 94% vs 73% in low- and high-MH groups, respectively (P 5 .0001). In a Cox model of progression-free survival including dichotomized MH, metabolic tumor volume, total lesion glycolysis (TLG), international prognostic index, and tumor bulk (mediastinal mass > 10 cm), as well as age as a continuous variable, only TLG (P < .001) and MH (P < .001) retained statistical significance. Using these 2 features to construct a simple prognostic model resulted in early and accurate (positive predictive value, 89%; negative predictive value, ‡90%) identification of patients at high risk for progression at a point that would allow the use of risk-adapted treatments. This may provide an important opportunity for the design of future trials aimed at helping the minority of patients who harbor chemorefractory PMBCL.

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Heterogeneity PMBCL final - Accepted Manuscript
Restricted to Repository staff only until 2 May 2019.
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More information

Accepted/In Press date: 5 April 2018
e-pub ahead of print date: 2 May 2018
Published date: 12 July 2018
Additional Information: Running title: Metabolic heterogeneity predicts PMBCL outcome

Identifiers

Local EPrints ID: 425329
URI: https://eprints.soton.ac.uk/id/eprint/425329
ISSN: 0006-4971
PURE UUID: a3a5b46e-c6f9-49d9-8902-c50ccb2b7abd
ORCID for Peter W. Johnson: ORCID iD orcid.org/0000-0003-2306-4974

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Date deposited: 12 Oct 2018 16:30
Last modified: 14 Mar 2019 01:49

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Contributors

Author: Luca Ceriani
Author: Lisa Milan
Author: Maurizio Martelli
Author: Andrés J.M. Ferreri
Author: Luciano Cascione
Author: Pier Luigi Zinzani
Author: Alice Di Rocco
Author: Annarita Conconi
Author: Anastasios Stathis
Author: Franco Cavalli
Author: Monica Bellei
Author: Kelly Cozens
Author: Elena Porro
Author: Luca Giovanella
Author: Emanuele Zucca

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